Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 129631 | CA |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | A129631 | CA |
NPI | 1063769883 |
---|---|
Provider Name | Pascual Dutton |
First Address | Escondido, CA 92025-4941 |
Second Address | Los Angeles, CA 90045-9212 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2012 |
Last Update Date | 11/01/2021 |